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The Milwaukee County Behavioral Health Division has signed an agreement with federal regulators to fix ongoing problems at its psychiatric hospital in Wauwatosa.The Milwaukee County Behavioral Health Division has signed an agreement with federal regulators to fix ongoing problems at its psychiatric hospital in Wauwatosa.

The Milwaukee County Behavioral Health Division has signed an agreement with federal regulators to fix ongoing problems at its psychiatric hospital in Wauwatosa. (Photo: John Schmid/Milwaukee Journal Sentinel)

The Milwaukee County Behavioral Health Division has signed a multi-year agreement with federal regulators to correct problems at the Mental Health Complex in Wauwatosa after a series of inspections found ongoing problems with documentation at the psychiatric hospital.

The agreement was signed last month with the federal Centers for Medicare and Medicaid Services and requires the Behavioral Health Division to take steps, including hiring an outside consultant, to address violations of federal regulations.

The Mental Health Complex provides inpatient and emergency care primarily to patients with severe behavioral health conditions who are in crisis.

The agreement was first reported by Wisconsin Health News.

In August 2018, a survey, or inspection, was done after an anonymous complaint that a patient was not adequately stabilized before being discharged.

The survey determined that patients were in immediate jeopardy for “failure to perform comprehensive medical screening exams or to stabilize and provide appropriate treatment prior to discharge for patients who presented to the Emergency Department,” according to the agreement.

Mike Lappen, administrator of the Behavioral Health Division, said the surveyors had to assume that the patient didn’t receive adequate care because of incomplete documentation.

The survey also found several other violations of the Emergency Medical Treatment and Labor Act, known as EMTALA. Those violations include failure to complete a log at the end of several patient visits.

EMTALA requires hospital emergency departments to screen every patient who seeks emergency care and to stabilize or transfer those who need emergency care regardless of whether they have health insurance or can pay.

The survey was done by the Wisconsin Department of Health Services. The Centers for Medicare and Medicaid Services contracts with the state agency to ensure that hospitals are meeting federal regulations.

A subsequent survey was done on Nov. 26, 2018, and federal regulators determined patients were no longer in “immediate jeopardy.” But the survey found the hospital was still not complying with certain provisions of EMTALA.

The violations, Lappen said, stemmed from incomplete documentation and problems with the hospital’s system for electronic health records.

Subsequent visits by state inspectors on Jan. 17 and March 5 found the hospital still was not complying with certain provisions of EMTALA.

A so-called recertification survey done March 13 by the state Department of Health Services and surveyors contracted by the Centers for Medicare and Medicaid Services then found the hospital was out of compliance with provisions regarding patient rights and requirements for medical records for psychiatric hospitals.

That survey, done to renew the psychiatric hospital’s license, found a new issue regarding documentation for patients who had been assessed at the emergency department to ensure  they met the standards to be involuntarily hospitalized, Lappen said.

Patients can be involuntarily hospitalized if a physician determines they are at immediate risk of harm to themselves or others.

The inadequate documentation involved four cases in which patients were brought to the emergency department to be assessed before they were to be admitted to other hospitals in the Milwaukee area, Lappen said.

“No hospital has a clean survey,” he said. “There is always something to improve on.”

The results of the survey, however, drew more attention because of the problems found in the previous surveys.

“That is how this became such a serious event,” Lappen said.

The Behavioral Health Division had the option of requesting another survey but could have been forced to shut down if the survey found violations.

The Behavioral Health Division determined the best course was to sign the agreement with federal regulators, Lappen said.

Under the agreement with federal regulators, the Behavioral Health Division did not admit to the problems cited in the surveys or that they were not corrected.

But it agreed to hire an outside consultant who will identify areas that need to be improved, determine their causes and recommend fixes.

The consultant, who must be approved by federal regulators, must fill regular reports with the Centers for Medicare and Medicaid Services.

The agreement will remain in effect through July 1, 2021.

Tom Lutzow, chair of the Behavioral Health Division’s board, said the board was told of the problems and that if the problems were serious the hospital would have been given 30 days to fix them.

The violations stemmed in large part from a new electronic health records system, said Lutzow, who is president and CEO of Independent Care Health Plan, known as iCare.

Lutzow said he saw value in bringing in a third-party expert. But he said the finding of new violations in subsequent surveys was a frustration.

“There was a little bit feeling of catch-up,” Lutzow said.

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